Background: Trimetazidine improves functional class and left ventricular function in patients with heart failure; however, its potential impact on QTc interval remains undefined. We analyzed the effects of trimetazidine on QTc interval in patients with ischemic heart failure.
Methods: A prospective trial included 42 patients with ischemic heart failure (New York Heart Association [NYHA] 2 or 3) and reduced left ventricular ejection fraction (<55%), who were randomly allocated to conventional therapy plus trimetazidine in a modulated release formulation (35 mg twice daily; 22 patients) or conventional therapy alone (20 patients; controls). We measured QTc interval at baseline and after 1 month.
Results: At baseline, QTc interval duration was similar in both groups (443 +/- 41 milliseconds in trimetazidine group vs 446 +/- 27 milliseconds in controls, P = .62). After 1 month, QTc interval decreased in the trimetazidine group (404 +/- 36 milliseconds, P = .0002) but not in controls (452 +/- 25 milliseconds, P = .74). QTc interval shortening with trimetazidine was more pronounced in patients with prolonged (>440 milliseconds) baseline QTc interval (-45 +/- 38 milliseconds) than in patients with normal QTc interval (-19 +/- 19 milliseconds P = .04). Significant QTc interval shortening (>20 milliseconds) was present in 14 of 22 patients (64%) in trimetazidine group compared to 3 of 20 (15%) patients in control group (P = .002).
Conclusions: Trimetazidine therapy is associated with QTc interval shortening in patients with ischemic heart failure.